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Influence of Dentifrice Abrasivity and Toothbrush Stiffness on the Development of Nccls in Vitro, Using Tridimensional Optical Profilometry

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Influence of Dentifrice Abrasivity and Toothbrush Stiffness on the Development of Nccls in Vitro, Using Tridimensional Optical Profilometry View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by IUPUIScholarWorks INFLUENCE OF DENTIFRICE ABRASIVITY AND TOOTHBRUSH STIFFNESS ON THE DEVELOPMENT OF NON-CARIOUS CERVICAL LESIONS By Fahad Binsaleh Submitted to the Graduate Faculty of the School of Dentistry in partial fulfillment of the degree of Master of Sciences in Dentistry, Indiana University School of Dentistry, 2016 ii Thesis accepted by the faculty of the Department of Operative Dentistry, Indiana University, in partial fulfillment of the requirements for the degree of Master of Sciences in Dentistry. ANDERSON T. HARA Chair of the Committee MARCO C. BOTTINO K. E. DIEFENDERFER FRANK LIPPERT N. Blaine Cook Program Director Date _____________________________ iii DEDICATION iv This thesis is dedicated to my parents, my wife, and my son for their support, love, and patience which were my inspiration to success. v ACKNOWLEDGMENTS vi First, I want to thank the God for giving me the health to continue my study and reach this level of education. I would like to convey my deepest gratitude to the Ministry of Higher Education and King Faisal Special Hospital and Research Center in Saudi Arabia for their scholarship and financial support that helped me continue my graduate education. I would like to express the deepest appreciation to my mentor Dr. Anderson T. Hara For his great guidance, help and support throughout the writing of this thesis. I also would like to thank my research committee members, Dr. N. Blaine Cook, Dr. Marco C. Bottino, Dr. Kim Diefenderfer, Dr. Frank Lippert for their guidance and suggestion and help throughout my research project. Special thanks to Mrs. Judy Haines for her help and support in the clinics, and Ms. Beth Moser for her work on the statistical analysis for the research. Finally, I would like to thank my family, my friends, and all Indiana University staff members for their patience, help, and support throughout my study. vii TABLE OF CONTENTS viii Introduction ....................................................................................................................... 1 Review of Literature ......................................................................................................... 5 Methods and Materials ...................................................................................................... 13 Results .............................................................................................................................. 20 Figures and Tables ............................................................................................................ 22 Discussion ......................................................................................................................... 35 Summary and Conclusions ............................................................................................... 42 References ......................................................................................................................... 44 Abstract ............................................................................................................................. 50 Curriculum Vitae ix LIST OF ILLUSTRATION x FIGURE 1. Specimen Preparation ................................................................................23 FIGURE 2. Specimens with protected and exposed areas ............................................24 FIGURE 3. A photograph of brushing machine............................................................25 FIGURE 4. Simulation of the bristles in contact with the specimen ............................26 FIGURE 5. Optical profilometer used in the project ....................................................27 FIGURE 6. Sensor used in the project ..........................................................................28 FIGURE 7. Means of tooth wear at 35K and 65K strokes, when using soft toothbrush associated to the different abrasive levels ..................................................29 FIGURE 8. Means of tooth wear at 35K and 65K strokes, when using medium toothbrush associated to the different abrasive levels ................................30 FIGURE 9. Means of tooth wear at 35K and 65K strokes, when using hard toothbrush associated to the different abrasive levels ..................................................31 TABLE I. Abrasive slurries composition. .................................................................32 TABLE II. Interaction between different toothbrushes and abrasives levels at 35K Stroke .......................................................................................................33 TABLE III. Interaction between different toothbrushes and abrasives levels at 65K stroke. .........................................................................................................34 1 INTRODUCTION 2 Non-carious cervical lesion (NCCL) is defined as loss of dental hard tissue near the cement-enamel junction (CEJ) caused by non-bacteria related processes. Three factors - erosion, abfraction and abrasion - have been considered as the common causative factors of NCCLs (Grippo et al., 1991; Levitch et al., 1994; Attin et al., 1997; Khan et al., 1999; Palamara et al., 2001; Eisenburger et al., 2003). The most common method to maintain good oral hygiene is toothbrushing (Wiegand and Schlueter, 2014), which is also considered to be a contributor to the development of dental abrasion (Addy and Hunter, 2003; Tellefsen et al., 2011;Wiegand and Schluter, 2014). Miller first noted the effects of toothpaste abrasivity on dental hard tissue in 1907 (Harte and Manly, 1975;Harte and Manly 1976). Such lesions can lead to dentin hypersensitivity (Bartlett et al, 2013), and also create areas for plaque retention, increasing the risk for caries development. In advanced stages, they can affect the dental structural integrity and pulpal vitality (Hollinger and Moore. 1979; Hong et al., 1988; Osborne et al., 1999). Currently, varying levels of toothpaste abrasiveness and toothbrush stiffness are known to affect the dentin. Prevention of NCCLs is important, since they may lead to pain or loss of tooth form, function and esthetics, especially when advanced (pathological) stages are reached. In those circumstances, restorative therapy may be provided; however, placing restorations does not necessarily stop the progression of the NCCLs and may have financial implications. 3 Therefore, research in this area should focus on understanding the main mechanisms related to NCCLs and how they can be prevented or modified. Major challenges to understanding NCCLs are the myriad of toothbrushing parameters (toothpaste, the stiffness of toothbrush, frequency, force, the direction of force, technique) that must be studied using clinically relevant models, and the lack of adequate quantitative methods to evaluate the NCCL progression. Our proposed approach to overcome these challenges involves primarily the establishment of a reliable evaluation method, which could be used for the study of the toothbrushing parameters in vitro and later in vivo. Considering the dental anatomy in the cervical area and the amount of anticipated surface loss, based on clinical observations, we proposed to use non-contact profilometry and tridimensional subtraction analysis as a promising approach to investigate the development of NCCLs. OBJECTIVE The study aimed to investigate the influence of dentifrice abrasivity and toothbrush stiffness on the development of NCCLs in vitro, using tridimensional optical profilometry. Null Hypotheses 1. The abrasive level of the dentifrice has no influence on the initiation and progression of NCCLs; 2. The stiffness of the toothbrush has no impact on the initiation and progression of NCCLs; 3. The interaction between the abrasive level and toothbrush stiffness does not affect the initiation and progression of NCCLs. 4 Alternative Hypotheses 1. The abrasive level of the dentifrice has a significant influence on the initiation and progression of NCCLs; 2. The stiffness of the toothbrush has a significant impact on the initiation and progression of NCCLs; 3. The interaction between the abrasive level and toothbrush stiffness does affect the initiation and progression of NCCLs. 5 REVIEW OF THE LITERATURE 6 Non-carious cervical lesions (NCCLs) can be defined as the loss of dental hard tissue near the cemento-enamel junction without bacterial involvement. Abrasion, erosion, and abfraction have been mentioned as common etiological factors of NCCLs (Grippo et al., 1991; Levitch et al., 1994; Attin et al., 1997; Khan et al., 1999; Palamara et al., 2001; Eisenburger et al., 2003), either independently or in association (Barbour and Rees, 2006). These etiological factors differ from one another depending on the tooth structure loss process. Abrasion is the loss of tooth structure due to friction by materials such as toothbrushes or abrasives in toothpaste (Lee and Eakle, 1984; Barbour and Rees, 2006; Ceruti, 2006). In contrast, dental erosion is the loss of tooth structure driven by acids. The acid could be from either extrinsic sources, such as the diet or medications, or intrinsic sources, such as gastric acid (Lee and Eakle, 1984; Passon and Jones, 1986; Rees and Hammadeh, 2004). On the other hand, abfraction starts due to the weakening of the tooth structure in areas of concentrated stress as a result of cuspal flexure from heavy and repeated occlusal loading, which progresses to dental hard tissue loss (McCoy, 1982; Lee & Eakle,
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